This site is maintained for Midwives in Private Practice (MiPP), a collective of independent midwives in Victoria. We are committed to the essence of midwifery, being 'with woman' - each woman and her midwife preparing to welcome the child she bears, working in harmony with and protecting intuitive natural processes in birth and nurture of the newborn and the establishment of loving, resilient families.

Monday, December 31, 2012

Letter to the Sunday Age

I find it troubling that some doctors are not happy with the
concept of independent experts who support a patient’s decision making in
medical care.

The statements by Dr Hambleton of the AMA suggest that he is
attempting to protect the old ‘doctor knows best’ position of privilege in our
society – perhaps that’s part of his job description?

I also take exception to Dr Hambleton’s questioning of “the
need for private midwives to be escorting women during hospital births.”

I am one of those private midwives, and I would like to
explain briefly why I provide primary maternity care, and attend birth, whether
it occurs in hospital or the woman’s home.

A midwife’s unique skill is the ability to work in harmony
with the natural processes through pregnancy, birth, and the postnatal
period. Birth is not an illness. The midwife’s duty includes promoting health, supporting wellness, and protecting the
woman’s ability to do the work of bearing and nurturing her children.
Only when and if complications or illness are present does the midwife
need to collaborate with medical and/or hospital systems, and only then with
the woman’s informed consent. Most women trust the midwife’s guidance,
but there are grey areas in maternity care, just as there are in the world of
GP doctors.

The planned setting for birth is not set in concrete.
Many women who plan hospital births experience the ‘coming ready or not’ baby
who arrives in all sorts of places, including the bathroom at home, the back
seat of the family car, or the hospital carpark or lift. Some women who
plan homebirth need to change their plan and move to hospital, for all sorts of
reasons.

Midwives who practise privately, independent of the hospital
system, are able to offer personal continuity throughout the episode of care
and be with the woman in labour wherever she is. Privately employed
midwives seek to establish a partnership with each woman in our care, at a
level that simply cannot be achieved without significant investment of time
prior to the birth. Privately employed midwives offer a distinct
professional care package to each woman. The women who employ us usually
intend to give birth spontaneously, without relying on medical pain
management strategies, or artificial augmentation of the birth process, unless
there is a valid reason at the time for such a decision to be made.

When private midwives ‘escort’ women to hospital, we have
usually provided significant professional services for that woman through the
prenatal period. Several Medicare items give rebate for services such as
the initial consultation, long or short antenatal checks, and the development
of an individual maternity care plan. The woman may have laboured at
home, in the care of her private midwife, prior to traveling to
hospital. The woman knows her private midwife’s voice, and touch, and is
able to be confident within the care plan. The care plan includes the
ongoing process of informed decision making, with the wellbeing and
safety of mother and child being the guiding principle.

Postnatally the private midwife continues to provide expert
professional services, within the primary maternity care relationship.
Postnatal Medicare items are available until the seventh week after the birth.

Dr Hambleton’s attempt to trivialise the private midwife’s
role as “so someone can hold their hand” is offensive to me. If I hold
the hand of a labouring woman, it is a significant act of professional support
for which that woman has employed me.

Midwives choosing to work privately, rather than being employed by hospitals, do so because it allows us to be flexible about the care we provide. We offer one-to-one primary care, which enables the woman and her midwife to establish a partnership based on trust and reciprocity.

Midwives who are interested in extending their practices to include a caseload and homebirth, whether as independent (self-employed) practitioners or as employees of a maternity service, are welcome to join in with MiPP activities. If you have a blog or website that you would like linked to this blog, or have other questions, please get in touch.

Thankyou for visiting this blog. I hope you will find it informative and useful. If you want to contact me by email, rather than leaving a message in the comments section of the blog, please do so joy@aitex.com.au.Joy Johnston